The Clinical Analysis Of Vaginal Intraepithelial Neoplasia Of 226 Cases

Objective:This article retrospectively analyzed the general conditions,clinical symptoms,signs,screening methods,risk factors,treatment methods,and follow-up prognosis of patients with vaginal intraepithelial neoplasia（Vaginal Intraepithelial Neoplasia,VaIN）,and discussed the clinical characteristics,diagnosis and treatment of vaginal intraepithelial neoplasia.Methods:We collected the clinical data of 226 patients with VaIN who were diagnosed by pathology in our hospital from January 2016 to June 2019.The patients’clinical data were followed up by outpatient and telephone.We analyzed the data with the help of SPSS 25.0software.At the same time,we retrospectively analyzed the relevant factors of VaIN,P<0.05,the difference was statistically significant.Results:1.The median age of VaIN I patients was 48（19,76）years,the median age of VaIN II patients was 48（22,66）years,and the median age of VaIN III patients was 55（34,67）years.The difference was statistically significant（P<0.001）.The median age of VaIN patients with CIN was 50（27,70）years,which was higher than that of patients with simple VaIN,which was 48（19,76）years（P=0.008）.2.Among 226 patients,183（81.0%）had abnormal TCT results.Of the VaIN I patients,62 cases of TCT results were ASCUS or LSIL,5 cases were ASC-H or HSIL.Of the VaINII-III patients,82 cases of TCT results were ASCUS or LSIL,34 cases were ASC-H or HSIL.There is a positive correlation between VaIN lesion grade and TCT results（Kendall’s tau-b=0.248,P=0.002）.216 patients（95.6%）were HPV positive,of which 115 patients underwent HPV-HC2 examination.The average HPV-HC2 of VaIN I,VaINII,and VaINIII patients were 625.72±770.28RLU/CO,857.68±523.87RLU/CO,1031.89±821.63RLU/CO,the difference between the three was statistically significant（P=0.049）.The HPV52 infection rate in VaIN I ranked first,and the HPV16 infection rate in VaIN II-III ranked first;The sensitivity of combined detection of TCT and HPV was higher than that of TCT or HPV alone（P<0.05）3.The lesion grade of VaIN has an important correlation with CIN.The more serious the cervical lesions,the higher the lesion grade of VaIN（Kendall’s tau-b=0.317,P=0.012）.4.The median interval between hysterectomy due to cervical disease and diagnosis of VaIN（30.5±17.60 months）was significantly shorter than those of non-cervical hysterectomy（72.95±44.59 months）.The patients with the same HPV type infection before hysterectomy as at VaIN tend to suffer from a higher grade of VaIN,but there is no statistical significance（P=0.232）.The average time for VaIN after laparoscopic hysterectomy was（31.71±21.84 months）,which was significantly shorter than that of patients undergoing abdominal hysterectomy（63.285±41.18 months）,and the difference was statistically significant（t=-3.542,P=0.001）.5.Among the 76 VaIN I patients followed up,34 patients were untreated and 42patients were treated.The effective rates of the two groups were 76.5%and 81%,and the difference was not statistically significant（P=0.634）.Among the 115 patients with VaIN II-III,20 patients underwent surgical treatment,95 patients underwent non-surgical treatment,of which 39 underwent CO₂laser vaporization therapy,36 underwent photodynamic therapy,19 underwent drug therapy,and 1 underwent non-treatment.The effective rate of the surgical treatment group was significantly higher than that of the non-surgical treatment group（P=0.041）.The effective rates of CO₂laser vaporization therapy,photodynamic therapy,and drug therapy were 76.9%,61.1%,and 31.6%,respectively.The effective rate of CO₂laser vaporization therapy and photodynamic therapy was not statistically different（P=0.138）;The effective rate of CO₂laser vaporization treatment and photodynamic therapy groups was higher than that of the drug therapy group,and the difference was statistically significant（P<0.05）.Conclusion:1.TCT and HPV detection have certain clinical value in the diagnosis of VaIN,and combined screening can improve the detection rate of VaIN.2.Part of vaginal intraepithelial lesions will be combined with cervical lesions.When colposcopy is performed for suspicious cervical lesions,attention should be paid to the examination of the vaginal wall to prevent missed diagnosis.3.Particular attention should be paid to vaginal lesions during the 2-3 years after hysterectomy due to cervical disease.TCT and HPV screening should be routinely performed during follow-up.4.Low-grade VaIN can be followed up regularly to avoid excessive medical intervention;Surgical treatment is the first choice for high-grade VaIN.Among non-surgical treatments,CO₂laser vaporization therapy and photodynamic therapy are better than drugs treatment.